The Utah COVID-19 Risk Score (often referred to as the Utah Risk Score or Intermountain Risk Score) is a clinical decision-support tool developed to identify non-hospitalized patients at the highest risk for severe disease.

Updated significantly in February 2022 during the Omicron surge, the score was utilized by the Utah Department of Health and Human Services (UDHHS) to prioritize the allocation of scarce outpatient therapeutics, such as Paxlovid, Sotrovimab, and Remdesivir (Webb et al., 2022).

The Scoring System (February 2022 Update)

The risk score is calculated based on a patient’s age, comorbidities, and vaccination status. Patients generally qualify for treatment if they meet specific “cut-off” points, which differ based on their immunization history (UDHHS, 2022).

1. Automatic Qualifiers

Certain groups were designated as “high-risk” and qualified for treatment without needing a calculated score:

• Residents of long-term care or correctional facilities.
• Unvaccinated individuals aged 75 or older.
• Severely immunocompromised individuals (e.g., recent organ transplant, active chemotherapy, or B-cell depleting therapies).

2. Calculated Risk Factors

For those who do not automatically qualify, points are assigned as follows:

(Source: MDCalc, 2022; UDHHS Crisis Standards of Care)

Eligibility Thresholds for Treatment

In February 2022, the UDHHS established the following score thresholds to determine eligibility for antiviral or monoclonal antibody therapy:

• Unvaccinated / Incompletely Vaccinated: Required a score of ≥ 6.0.
• Vaccinated (Primary Series Complete): Required a score of ≥ 8.0.
• Unvaccinated & Pregnant: Required a score of ≥ 4.0.

Clinical Rationale: The higher threshold for vaccinated individuals reflects the significant protection vaccines provide against hospitalization, meaning a vaccinated person typically needs more underlying risk factors to reach the same level of absolute risk as an unvaccinated person (Webb et al., 2022).

Development and Validation

The tool was derived from data provided by Intermountain Healthcare, analyzing over 100,000 COVID-19 cases in Utah. The researchers found that the model had an Area Under the Receiver Operating Characteristic (AUROC) curve of 0.82 for predicting hospitalization, making it a highly accurate tool for outpatient triage (Webb et al., 2022).

While the score initially included Race and Ethnicity as a weighted factor (2 points) due to observed disparities in hospitalization rates, the UDHHS removed this specific point-based weight in early 2022 following legal and ethical reviews, opting instead for a focus on underlying medical vulnerability and clinical scarcity (Gephardt Daily, 2022).

References

1. Webb, B. J., et al. (2022). Simple scoring tool to estimate risk of hospitalization and mortality in ambulatory and emergency department patients with COVID-19. PLoS ONE, 17(3), e0261508. https://doi.org/10.1371/journal.pone.0261508
2. Utah Department of Health & Human Services (2022). Utah Crisis Standards of Care: Scarce COVID-19 Therapeutics Allocation Guidelines. [Official State Guidance updated Feb 2022].
3. MDCalc (2022). Utah COVID-19 Risk Score. Retrieved from https://www.mdcalc.com/calc/10410/utah-covid19-risk-score
4. Gephardt Daily Staff (2022). ‘Extreme scarcity’ of COVID-19 treatments in Utah leads to new risk assessment guidelines. Gephardt Daily.